NPIMap

Organization Active NPI

Janesville Psychiatric Clinic Main Inc

  • Mental Health Counselor
  • Janesville, WI
National Provider Identifier
1659447704
Registry record updated Nov 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1448 Issued in WI
Legal business name
JANESVILLE PSYCHIATRIC CLINIC MAIN INC
Practice address
15 W Milwaukee St
Suite 206 & 207
Janesville, WI 53548-2998
Phone
(608) 755-1475
Fax
(608) 755-1733
NPI assigned
Nov 28, 2006
Last updated
Nov 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Hollingsworth
Title
Clinic Director, Owner
Phone
(608) 755-1475

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1448 WI
Mental Health Counselor 101YM0800X 1448 WI Primary
Psychologist 103T00000X 1448 WI
Clinical Child & Adolescent Psychologist 103TC2200X 1448 WI
Clinical Social Worker 1041C0700X 1448 WI
Marriage & Family Therapist 106H00000X 1448 WI

Addresses

Primary practice location

15 W Milwaukee St
Suite 206 & 207
Janesville, WI 53548-2998

Mailing address

15 W Milwaukee St
Suite 206 & 207
Janesville, WI 53548-2998
Phone (608) 755-1475

Other identifiers 3

IdentifierTypeStateIssuer
43007200MedicaidWV
42123800MedicaidWI
1659447704MedicaidWI

National Provider Directory

National Provider Directory

Locations

20 E Milwaukee St
Ste 210
Janesville, WI 53545
Phone (608) 755-1475

2640 Milton Ave
Janesville, WI 53545
Phone (608) 755-1475

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446422400000",
    "number": "1659447704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 W MILWAUKEE ST",
            "address_2": "SUITE 206 & 207",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482998",
            "telephone_number": "608-755-1475",
            "fax_number": "608-755-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 W MILWAUKEE ST",
            "address_2": "SUITE 206 & 207",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482998",
            "telephone_number": "608-755-1475",
            "fax_number": "608-755-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANESVILLE PSYCHIATRIC CLINIC MAIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-11-02",
        "status": "A",
        "authorized_official_last_name": "HOLLINGSWORTH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CLINIC DIRECTOR, OWNER",
        "authorized_official_telephone_number": "608-755-1475",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "1448",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "1448",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1448",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "1448",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1448",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1448",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43007200",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42123800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659447704",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.